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Legalising Assisted Dying: Ethical Dilemmas and the UK Parliamentary Discourse

Updated: Dec 30, 2023

Written by Jasmine Teo for the Medical Law Section.


Source: Sky News

It appears that there has been a persistant need for a legal framework that supports and regulates assisted dying: the UK is currently unable to do this. This article details the negative impacts of this inability on a vulnerable demographic of the UK population, and the urgency of the matter.

The landscape of assisted dying in the United Kingdom is currently governed by Section 2(1) of the Suicide Act 1961 (‘SA 1961’), which renders any intentional assistance or encouragement for suicide a criminal offense. This stringent legal stance has faced repeated attempts at reform, with one of the most notable endeavours being the Assisted Dying (No. 2) Bill (‘The Bill’) in 2015. This legislative proposal drew inspiration from the Oregon Death with Dignity Act, striving to provide an avenue for individuals facing terminal illness or possessing a life expectancy of six months to opt for a peaceful and assisted end to their lives.[1] Despite representing a pioneering effort towards reform, the Bill encountered a resounding defeat of 330 to 118 in the House of Commons, where it sought to empower competent adults with terminal illnesses to request assistance in peacefully ending their lives. Distinguishing between assisted dying and assisted suicide, the former emphasises the autonomy of terminally ill individuals over the manner and timing of their imminent death, while the latter is a broader term encompassing anyone's choice of death over life.[2] For the purposes of this article, the focus will be on assisted dying. Assisted dying remains a contentious and highly debated ethical issue in the UK. The following exploration delves into the ethical considerations, safeguards, and potential risks that come with legalising assisted dying in the country.

 

Ethical Considerations

Central to the ethical debate surrounding assisted dying is the question of whether the authority to make decisions on this matter should predominantly rest within the legislative domain of Parliament or involve judicial intervention. This ethical dilemma was brought into focus notably in the legal case of R (on the application of Nicklinson and another) v Ministry of Justice,[3] where the applicant suffered a stroke, rendering him paralysed from the neck down and unable to speak. A judiciary majority opposed declaring the SA 1961 incompatible with Article 8 of the European Convention of Human Right’s right to respect for private life, per section 4 of the Human Rights Act 1998. Lord Neuberger was of the view that Parliament should change the law itself without the need of a formal declaration proving necessary. However, Lord Neuberger was willing to make a declaration of incompatibility. Whilst the courts should actively seek to engage on whether autonomy demands freedom in assisted dying, or if the sanctity of life must be upheld, it is ultimately a question for legislators.

 

Another ethical consideration revolves around the concept of safeguarding vulnerable individuals. The ‘slippery slope’ argument is often invoked against the legalisation of assisted dying, suggesting that permitting such practices could be a double-edged sword by extending beyond the intended scope, leading to potential abuse or misuse of the law.[4]  This perspective emphasises the challenges associated with controlling the practice once it is legalised, raising concerns about the illegal dispensation of lethal drugs or the falsification of certifications.

 

 

Safeguards and Risks

Critics, including Jackson, fear that once permitted, it would become challenging to limit this practice only to those in severe, unmanageable agony.[5] Despite misconceptions, the ‘slippery slope’ argument is not solely about the moral stance on doctors aiding patients in dying. Rather, it underscores the potential for abuse and the difficulties in controlling the practice once it becomes legalised. There is a fear that legalising assisted dying could create loopholes, making it harder to prevent illegal dispensation of lethal drugs or falsification of certifications, leading to situations that could be challenging to detect and manage. This perspective by Jackson adds a layer of complexity to the debate, emphasising the potential unintended consequences that might arise from assisted dying’s legalisation, even in cases where it might seem justifiable on compassionate grounds for terminally ill individuals.

 

Parliamentary Response and Ongoing Discussions

Amidst these ethical quandaries, the evolving landscape of assisted dying in neighbouring regions is exerting significant pressure on Members of Parliament (MPs) in the UK to take action. Developments in Scotland, the Isle of Man, and the Republic of Ireland where discussions, consultations, and debates are underway concerning assisted dying, are resonating within British parliamentary circles.[6] Scotland's Liam McArthur’s Bill is making steady progress, while the Isle of Man has initiated consultations to potentially legalise assisted dying for terminally ill individuals through Dr. Alex Allinson’s Private Member’s Bill. This initiative gained overwhelming support with a vote of 22-1, reflecting the growing momentum toward providing choices for individuals facing terminal illnesses.[7] Beyond immediate borders, the Republic of Ireland is gearing up for debates and seeking public opinions on assisted dying. The launch of a Special Oireachtas Committee, prompted by the progress of Gino Kenny TD’s Death with Dignity Bill that secured favourable votes in October 2020, signifies a significant step toward engaging with this issue. Notably, polling results reveal substantial support (63%) for assisted dying in the Republic of Ireland, with minimal opposition (18%).[8] The collective advancements and discussions in these adjacent territories underscore the urgency for UK MPs to actively engage with the topic of assisted dying. As discussions, consultations, and initiatives gain traction, the need for thoughtful consideration and responsive action within the UK’s legislative sphere becomes increasingly apparent.


Conclusion

In conclusion, the UK’s landscape concerning assisted dying navigates a complex intersection of legal constraints and ethical dilemmas. The rejection of the Assisted Dying (No. 2) Bill underscores the ongoing debate surrounding the autonomy of terminally ill individuals. Ethical considerations revolve around protecting vulnerable groups while grappling with potential loopholes and unforeseen consequences if legalisation were to occur. Ongoing discussions and advancements in neighbouring regions emphasise the pressing need for UK lawmakers to address this issue. As deliberations intensify, a balanced approach that respects individual autonomy while addressing societal responsibilities remains an essential consideration.








References

1.     Blake A and Tracey A, ‘Manx Politicians Consider Bill to Allow Assisted Dying’ (BBC News, 31 October 2023) <https://www.bbc.co.uk/news/world-europe-isle-of-man-67262459> accessed 30 November 2023.

2.     Delbeke E, ‘The Way Assisted Suicide Is Legalised: Balancing a Medical Framework Against a Demedicalised Model’ (2011) 18 European Journal of Health Law 149.

3.     Hall F, ‘Law Change Is Coming in the UK and Beyond’ (Dignity in Dying, 2 December 2022) <https://www.dignityindying.org.uk/blog-post/law-change-is-coming-in-the-uk-and-beyond/> accessed 30 November 2023.

4.     Jackson E, ‘Euthanasia Isn’t A Slippery Slope’ (IAI TV - Changing How The World Thinks, 27 January 2020) <https://iai.tv/articles/euthanasia-isnt-a-slippery-slope-auid-2036?_auid=2020> accessed 30 November 2023.

5.     Moss Z, ‘Assisted Dying Not Assisted Suicide’ (Dignity in Dying, 10 April 2013) <https://www.dignityindying.org.uk/blog-post/assisted-dying-not-assisted-suicide/> accessed 30 November 2023.

6.     Reilly C, ‘Assisted Dying: Where Does Irish Medicine Stand?’ (Medical Independent, 27 August 2023) <https://www.medicalindependent.ie/in-the-news/news-features/assisted-dying-where-does-irish-medicine-stand/> accessed 30 November 2023.

7.     R (on the application of Nicklinson and another) v Ministry of Justice [2014] UKSC 38.

8.     Smith SW, ‘Fallacies of the Logical Slippery Slope in the Debate on Physician-Assisted Suicide and Euthanasia’ (2005) 13 Medical Law Review 224.


[1] Evelien Delbeke, ‘The Way Assisted Suicide Is Legalised: Balancing a Medical Framework Against a Demedicalised Model’ (2011) 18 European Journal of Health Law 149, 152.

[2] Zach Moss, ‘Assisted Dying Not Assisted Suicide’ (Dignity in Dying, 10 April 2013) <https://www.dignityindying.org.uk/blog-post/assisted-dying-not-assisted-suicide/> accessed 30 November 2023.

[3] [2014] UKSC 38.

[4] Stephen W. Smith, ‘Fallacies of the Logical Slippery Slope in the Debate on Physician-Assisted Suicide and Euthanasia’ (2005) 13 Medical Law Review 224.

[5] Emily Jackson, ‘Euthanasia Isn’t A Slippery Slope’ (IAI TV - Changing How The World Thinks, 27 January 2020) <https://iai.tv/articles/euthanasia-isnt-a-slippery-slope-auid-2036?_auid=2020> accessed 30 November 2023.

[6] Fran Hall, ‘Law Change Is Coming in the UK and Beyond’ (Dignity in Dying, 2 December 2022) <https://www.dignityindying.org.uk/blog-post/law-change-is-coming-in-the-uk-and-beyond/> accessed 30 November 2023.

[7] Alex Blake and Ashlea Tracey, ‘Manx Politicians Consider Bill to Allow Assisted Dying’ (BBC News, 31 October 2023) <https://www.bbc.co.uk/news/world-europe-isle-of-man-67262459> accessed 30 November 2023.

[8] Catherine Reilly, ‘Assisted Dying: Where Does Irish Medicine Stand?’ (Medical Independent, 27 August 2023) <https://www.medicalindependent.ie/in-the-news/news-features/assisted-dying-where-does-irish-medicine-stand/> accessed 30 November 2023.

 

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